Talking therapies & ECT

In addition to medication, a range of treatments are available for people with mental health problems. Rethink and the Royal College of Psychiatrists provide information about the range of treatments available, some of which is adapted here.

Psychodynamic psychotherapy involves talking about past experiences and how they affect the present.

Behavioural psychotherapy involves spending time in a feared situation or learning techniques to reduce anxiety to try to change patterns of behaviour.

Cognitive Behavioural Therapy (CBT) involves talking about how what you do affects your thoughts and feelings and aims to get rid of destructive ways of thinking.

Family and relationship therapy focuses on relationships and involves all the people concerned, either a couple or the whole family.

Individual psychotherapy involves one patient and one therapist.

Group therapy involves several people with similar problems meeting together with a therapist.

Counselling aims to improve self-acceptance and can help people deal with conflicts or to make decisions. In counselling, people can talk about their thoughts and feelings without fear of being judged or criticised.

Creative therapies

Inart therapy, clients' responses to the created art are thought to reflect their concerns and conflicts.

Drama therapy aims to help clients to tell their story, solve problems and improve interpersonal skills and relationships.

Music therapy uses music as a means of communication and expression and to facilitate positive changes in behaviour and emotional wellbeing.

Art, drama and music therapists are trained in art, drama or music and therapy.

People wanted to try talking therapy because they wanted to talk to someone and hoped it would help, including one woman who was hopeful even though she realised that “they won't have a secret recipe”. Some were willing to try talking therapies even though they didn't know if it could work or had tried it before, while others felt that talking with others is helpful, even though talking therapies didn't work for them personally. One woman was worried about how long she might have to have therapy, partly because she felt, “therapy was for the mad people”.

So anyways I went directly to the psychiatrist and he told me that, 'I'm not going to give you any medicine.' Maybe he would have given me the reason that I was too young or something like that, which I can't remember. But mainly he told me, 'Look, this is a psychologist. She works in this hospital. Go and see her, and have a few sessions with her, and then we'll see how things go.' I said, 'All right.' So I went to see her I think altogether about three times, where we had a one hour session each time, more or less, and she didn't charge me anything or anything like that. She was very nice. She listened to everything. She was actually a college professor, and a psychology professor. So she listened to me quite a lot. And she gave me quite a bit of time, and I felt actually better during that therapy.

But at the end of the day I think I was just too young to be patient enough to keep on going to therapy and talking about rubbish. I think it becomes a bit boring as well after a while. You know, 'This happened, and that happened.' You need a fix. You know what I mean? Like your mind isn't working properly. You are in pain, you need a fix. You don't want to talk rubbish for months. You just need a fix. So I think I was just too impatient. I was probably doing drugs as well. So, you know, I thought, 'Sod it.' And that's it.

People had mixed opinions about talking therapies. Some had found them helpful and thought that they were “the only way to get oneself moving forward”. Others experienced mixed results. One woman with schizophrenia said CBT “improved my quality of life quite immensely”, although it was difficult to use when she was unwell. One man with anxiety disorder said that CBT helped him to become aware of his anxieties but trying to replace his patterns of thinking didn't work (see Shaukat's story). He doubted whether CBT made much difference but said it was difficult to tell because he was also attending support groups.

I mean do use kind of stuff like CBT which is Cognitive Behavioural Therapy to kind of stop it getting any bigger. Sometimes it helps. Actually most of the time it helps but there are some certain occasions where I'm always having a kind of rough time anyway, and I'm not sleeping, or I've just been physically ill, so CBT is hard to kind of use. Then it does happen, it happens less frequently but it still happens.

So when it does work, how does that help?

Well for example' the last time I used CBT effectively is that sometimes I think that people are clones, that they're not really the people they say they are. And my kind of CBT therapist said, 'Why do you think that is?' I say, 'Because the other people are acting strangely.' And so we kind of broke it down and what she found, what we found is that' I was already slightly becoming unwell, so people's response to me, their kind of attitude would shift, because they will say, you know, 'There's something amiss with Dolly.' So their, their attitude would change, but I was misinterpreting that change. I was thinking that that was proof that they were clones, because they were acting different. But she said, 'No. It could be that because you're acting slightly different way, they are acting slightly different.' So I mean that kind of really stopped that. That kind of psychotic episode from being bigger than it was. So' it was just breaking the things down, and just seeing, you know, psychosis isn't, isn't random it does follow a certain path and your thinking and your behaviour helps feed that, you know, directs that path, so to speak.

What is that path then, can you explain?

Well we've all got a set way of thinking and, you know, for example this, this clone thing. I would always assume that the other person's kind of difference in attitude was there was like only one reason for that. So that was the usual path that I went down. So the CBT provided me kind of another path that, that was kind of more truthful and more showing what was, you know, really, happening. So, I think that's what, you know, CBT has kind of shown me your thinking can change the psychotic experience so that's what I mean really.

Therapy can offer an environment to talk about difficult or sensitive issues, and many people described needing to talk about abuse, bereavement, or feelings of anger and valued the opportunity to talk about their feelings, “I have to take that out of my chest and I feel better then”. One woman benefited from writing letters to family members and reading them aloud in group therapy. Many people valued the improvements in their understanding, being able to unpack their feelings, and felt as though talking therapy gave the “power back to me, not to my symptoms” and helped them feel calmer.

The therapists' background - ethnicity, class, spiritual beliefs or education - and their approach or attitude may also affect the relationship between clients and therapists. Some people found these characteristics made their therapist difficult to relate to, while others found them irrelevant.

Voluntary development coordinator, single with 2 adult children. Ethnic background/nationality: Black-British (born UK).

So I had a counsellor, who was absolutely rubbish, who then told me about a BME counsellor, who was equally rubbish, who then led me on to another counsellor, who was excellent. And she was a white Irish woman and she allowed me to explore my feelings. I think that's probably the best way to put it. She never actually ever said that much, I have to say. But when I started to feel some kind of understanding and recovery, I talked to her about what type of counsellor she was. And she said, she must have told me right at the beginning but I can't remember, she said she was a person-centred counsellor. And I thought, 'Wow. This is really, really good.' Because for the first time in all the so-called care that I've had somebody is allowing me to make my own choices, come to my own conclusions. And they're not telling me that it's wrong or it's right, they're just allowing me to explore. And, and in some ways, you know, it's so subtly, but forcing me to think things through. Never giving me the answer to the next step. Allowing me to think about what could be my next step and what's the pros and cons of my next step and really thrash it out. And maybe, you know, there'd be one question for a session and, and that's all we'd ever get to by the end of the session, just coming to grips with what the question was, sort of thing.

And I had counselling for nearly a year, every week, one hour, and it was fantastic. And she was a volunteer. So then I decided, 'I'm going to be a counsellor. I'm going to be a counsellor.' And I went off and found an Introductory and a Certificate too and I started this person-centred counselling. And it was probably the worst thing that I ever did, because being a person-centred counsellor requires you to look at yourself. And looking at myself was not always a good idea, because I often didn't like what was revealed to me when I started really looking. So it was a struggle to finish this course. And I had lots of challenging conversations with members of that group, that training group. And the tutors were fine, but it was really hard work. So by the time I got to the end of the certificate I decided I didn't want to be a counsellor, because if this is what the certificate feels like, God knows how hard the diploma is going to be. I don't think my mind can take it. And all my friends would just have a field day. And I think they did have a field day with the whole concept of me delving into my head. I didn't often do that.

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Profile Info

Age at interview:

31

Sex:

Female

Age at diagnosis:

17

Background:

Mental health worker, single. Ethnic background/nationality: Asian.

I think I find it difficult anyway talking to mental health professionals because they do, even if they're not white, they are middle class, and I don't know I think probably as I felt a lot of my life, you know, like I went to private school when I wasn't like middle class and stuff and I have, I have got this thing about, I suppose I've got an inferiority thing, about, you know, people who are like clever and posh and stuff. I mean there wasn't anything wrong with her, you know, she was a nice enough person, it was just when I was assessed I had said that I had these eating problems, and I'd also said that one of the other thing I had was that I was convinced for years and years that I was really, really ugly. I mean nowadays I don't get it so much. I mean I know I'm not beautiful or anything, but you know, I am kind of average okay, fine, great [sniffs]. But I was really, really distressed at that point, about my facial appearance, I thought that I was really, really hideously ugly, and a lot uglier than other people, you know, and I'd said that. And there's plenty of other people they could have given me as a therapist, but who did they give me? This like kind of, I don't know, she was just, she was very kind of beautiful and thin and, and, I just sat there feeling really, really inferior. And I think as well because she is a psychologist, and I was a graduate and I kept thinking, 'But I should be doing what you are doing, and why am I sitting here in this chair?'

…And now I have a counsellor, and it's Christian counselling. It's… It's a space that although when I'm there, I know that it's helping me unpack stuff, and I know that it's helping me sort through the dross in my life and just getting rid of it, bit by bit. But before it on a Tuesday it's really, really difficult because I'm preparing for that session. I don't know what is going to come out in that session and I don't know how it's going to leave me feeling to travel back home again. But I really look forward to it though in a strange way.

My counsellor is really, really brilliant. And she, she's a white woman and she doesn't, so clearly, you know, the counsellor doesn't necessarily have to be the same ethnic background as the client. But what she does do, is she's really open and she hears what I say. And she has a way of asking me questions that makes me stop and think and search for myself. And we've been through a lot of stuff and now we are looking at what I can do to become more positive. What I can do to, you know, enhance the positives in my life, what are the definitions of success for me? And how I can make that happen.

Well the counselling takes place in a church. It's Christian counselling. So I know that my counsellor will have a Christian belief. No, no, it's an assumption, that's an assumption. Because it's a, it's pastoral centre, so that doesn't automatically assume that every counsellor is a Christian. But I believe that my counsellor is a Christian. She, the language that I use in my counselling is like, you know, very Christian language, and she is not phased by it, and she doesn't feel the need to analyse it or have me explain it or anything like that, she just knows what I mean. She also is able to make me feel… that… she's the small one in the room and I'm the big one, and I think that having that kind of feeling or being able to convey that kind of feeling is really powerful, because she is smaller than me, but she somehow allows me to feel as though, almost as if I fill that room. It's all about me, and it's all about my stuff, and it's all about, but there's no judgement, you know, lots of words are out there, but there's no judgement about those words.

Many people praised the skill and approach taken by their therapist, and this was what often made the difference between a good and a bad experience. The main things that people valued from their experience of talking therapies were having someone to talk to who listened, seemed to understand and believe them, and helped them to feel empowered in the session. Many people tried more than one therapist before they found the right one for them.

This counsellor was my second one from this organisation. The first one that I saw was really odd. I knocked on the door, and she kind of, she opened it, and she saw me, and she kind of half closed it and stood behind it and said, 'Can I help you?' And that put me off. That just put me off and I just told her who I was. And she said, 'Oh, okay,' and she stepped back and she let me in.

But then in the counselling room she crossed her legs. She put her right ankle over her left knee and then she held her ankle with her hand. So she was completely closed down from me. And I just thought, and she kept encouraging me to open up and, you know, to share things and all of that and I just couldn't feel safe. I could not feel safe. And she didn't give me any idea when we were coming to the end of the session, so I could start packing myself back together ready to leave. She just said, 'Right the session's over now. So it's next week.'

And I just thought, had I share stuff with you I would have been going out there, and all of my rage would have been in tatters. I probably would have killed somebody. And so, but then they got me this counsellor and she's really brilliant. She is so brilliant. The first session she just, you know, asked me, about something that was on the assessment form already. Which was brilliant, because I just thought after going through that assessment, I didn't need someone to say to me, 'Well, you know, tell me about yourself. Why are you here?' And my feeling would have been, well, you know, it's on the paper, read it. So, but she was asking me questions and it was really brilliant. I still, she sussed that I have a face for counselling, I have a face for work, [laughs] I have a face for everything, but the real me, is someone that's still well protected inside, and, you know, will this person ever come out.

She has a way of, [small cough] excuse me, she has a way of using silence as well, and because I don't fear silence, we can just sometimes sit in silence and I'm looking at her and she's looking back at me. And I am not' yes? [laughs] Yes? And, but sometimes the way that I perceive she looks at me, it's as if she's, you know, peeling back the layers. And almost as if she is actually getting right into me. And with her, that doesn't feel scary. It doesn't feel scary but it feels like, 'Oh my gosh is she going to see something, before I am ready to share with it with her?'

But I do, like I was saying earlier, on a, on a Tuesday I get a bit stressed on the day, you know, anticipating what is going to come out, what it's going to be for me, how am I going to feel when I leave, those kind of things, but whatever comes, whatever happens, when I am on my way home afterwards, even if I am feeling down, even if I am feeling, you know, elated, even if I am kind of, I am aware that it's part of my process to getting well.

Where, you know, I can have my naturally induced endorphins back. The first couple of sessions I attended and then I missed one and then I attended, and then I missed one. But I'm really making every effort not to miss any now. And so that, you know, the process can continue. Yes.

And with the first woman that you went to see, you said, the minute she opened the door and hid behind it again, that immediately put you off. What was it about that?

Because what I saw in her face was fear. And she was expecting me, so I wouldn't have expected her to be fearful when she opened the door, because my form would have sort of described me. And so to see that fear on her face and then I was going to be vulnerable with someone who feared me, I was then concerned wel

Although talking therapies are available free on the NHS or from voluntary organisations, there can be long waiting lists. Some people had asked their GP for talking therapy and had to wait for at least 6 months, others hadn't asked and hadn't been offered any. One woman said she was finally on the waiting list for psychotherapy after waiting 22 years for a referral. It is possible to pay to see a therapist who works privately but some couldn't afford it, although many therapists offer a sliding scale of payment based on what the person earns. One woman who had been having psychotherapy since she was a child thought that there was a difference between the psychotherapists working for the NHS and those working privately. A few people described feeling pressured into having talking therapy, including one man tried it even though he didn't think it would help because he was worried he wouldn't get any further help.

But it's not so much that even, it's just, you know, the fact that I didn't have it, and they kept saying I did, and that they wouldn't listen to me, you know, even when I could put together a perfectly coherent clear rational argument as to why I didn't have it, and they still, they'd made up their minds that was what fitted and that is what they were going to do. And I mean like they said things like, they would offer me cognitive behaviour therapy to persuade me that I was ill with schizophrenia and that I needed to take medication.

Like that was the only way that they would offer me, they wouldn't offer me, like therapy for, it would just be so that I could learn that I really do have this illness that I keep saying I don't have. You know.

Was it put like that?

It was yes, it was like, 'Oh we could refer you for cognitive behaviour therapy and would give you insight and so to persuade you that you need to take your medication and give you an understanding.' And it's kind of like brain washing really'

I think trying to do it, trying to get rid of your depression by psychological work is quite hard, you have to work quite hard just to keep yourself, kind of just treading water. And all the cognitive behaviour stuff and the affirmations and, you know, doing some exercise to raise your endorphins and making sure you eat healthily and it's just like it's a job in itself, you know, and there are people out there who are just, like they don't have to do any of that, they're just normal, they can just enjoy life, and just like, they know how to talk to people and stuff, they don't have to like learn how to do it, and I just don't understand, and I think, oh is that possible?

Others thought that talking therapies were “a waste of time” and “don't work”, including one woman who said her counsellor and psychologist “couldn't help me; nobody really knew what to do with me”. A few people said that the creative therapies they had tried hadn't helped them, including one man who said he wanted to do “proper drama”. Talking therapies can only work if people are willing and able to talk about their experiences, which some people found difficult, “I knew I needed to talk to someone but I didn't really know what to talk about.”

Single. Ethnic background/nationality: Black-African (born in Zimbabwe); in UK for 7 years.

Did you do anything like group therapy or anything like that?

No.

No?

No.

Have you had any other kinds of treatments, I'm thinking of things like, things that other people have talked about like counselling?

No, someone told me I should go for counselling but I don't think its going to help, it's going to make it worse, it's going to bring back stuff that I've forgotten about.

Right, okay. So you'd rather not try that?

No.

Who was it that suggested it?

Some woman at refugee council, Refugee Action.

Some people found it a drawback that counsellors only listen and do not offer advice in their sessions. Therapy can also be a slow, time consuming process and “hard work”. Some people preferred medication because it provided a quicker fix, or when talking therapies didn't help [see Ali above].

Then I went to see the psychiatrist. They tried different, different medications. None of them worked. Then they said to me, 'Oh come along for talking therapy.' I told them, 'Hold on. What can I talk? If I had a problem I could say so.' Then they said, 'Oh well if you don't, then you are not cooperating with us. Then we will drop you.' So then I said, 'Oh well, you're only going to waste your time, but I thought I would mention this to you.' Then I went through the ruddy talking therapy. I knew nothing is going to happen. But still I maintained a positive attitude. After ten weeks of talking therapy, nothing happened'

Ah well talking therapy, well, you may be aware, there are two types of depression. One is the reactive depression and the other is indigenous depression. Now, the react' not to talk down to you, but if you didn't know, the reactive depression, say if you lose your job, if your loved one died, then you're worried thinking about it and all these things. Then you need somebody to talk to you, to come to terms with it. But the indigenous which the brain stops producing serotonin, well, whatever talk you do, it's not going to work, you see. So therefore, I told my psychiatrist talking therapy doesn't work, but then I went through it, and that was it what could they say. They said, 'You have got a problem. Look at things positively.' Now I am a positive person. You see I left school with O-levels and I became a group audit manager for a group of companies. Right. And I've found many frauds, commended by Old Bailey judges, and even at this stage I am saying this. I don't need some zombie to tell me, 'Be positive.' You know what I mean'?

But of course you can go to some of these professional listeners, by they are like a plastic thing, they smile and listen. And also another thing though, when you go for counselling, the counselling philosophy is that they mustn't give advice. They must help you to make your mind up. Right but when you are really suffering, you want somebody to tell you what to do.

A few people had also done some counselling training [see Jay, above and Nelsy, below], and from this experience, one woman concluded that language and communication were crucial for therapy.

Former teacher, now describes herself as a "natural community builder", married with 1 adult and 1 teenage child. Ethnic background/nationality: Latin American (born in Colombia); in UK for 19 years.

What I really want to say is that the language and communication are so crucial in therapy. And I was saying that talking with people is never the same as talking to people. But we normally say talking to, I'm talking to Maria, talking to Juan, John to whoever. That sounds patronising. If you talk with someone it is different because there is a relationship that comes and goes. So the way we use the language and the words that we use had a lot to do with mental health, a lot, because we just repeat and repeat everything. It's like the word 'mind'? What is 'mind'? I don't use the word mind because mind is so many things and at the same time it is nothing. So yeah it's questioning almost everything, everything that I was doing. And perhaps because I studied linguistics, the language became for me very crucial. Very and it helped me. So in the end it's a lot of circumstances in my life that together make me a different person that I am now.

When I really became aware and conscious of everything, putting my own ideas and answers to my own questions, I came out as a totally different person which I am very pleased I am. And yeah I always wanted to be a calm person since I was working, there was a teacher who was so soft and so gentle, I wished I was like her, and now I can say I am [Laughs]. Having an easier life, my whole philosophy of life is totally different. It's a pleasure, life is a pleasure, it's not a rush, a pain any more.

And so did you experience difficulties expressing yourself, for example in therapy or'?

Oh yes, yes, I, the fact that I was not confident about English, about my English, put me off. Within this counselling course, it's when I came about how important it was for me to speak up. The first day it was about 50 people sitting in, in a room and, and I, in my own view they were all, all of them were English and because they spoke very well and easily. And it was nearly the end of the day and I hadn't said a word and my heart began to go [gestures], so it was following my feelings that I learnt to speak because I remember saying at the very last minute I want to say something, shaking and I said, 'I'm shaking.' And I explained that, 'I'm a foreigner, this is the first time I'm in a room with so many English people, English speakers that speak so fluently and so easily, but my heart is coming out.' So expressing exactly what I was feeling, that was all I needed. So that was another big, big lesson.

For some people, talking therapy caused distress, including crying and feeling “down”, tired, stressed, or empty, “it just opened a hole, and it's left me with that hole really”. People welcomed the support of other people in group therapy, although one woman also described feeling angry when she didn't get the opportunity to speak during a session. Some people who felt this way thought that the six sessions they received were inadequate, including one woman who was left with suicidal feelings.

Former teacher, now describes herself as a "natural community builder", married with 1 adult and 1 teenage child. Ethnic background/nationality: Latin American (born in Colombia); in UK for 19 years.

And then came the counselling, six sessions of counselling where I began to talk about my anger with my parents and with many people, just mentioning it because six sessions were not enough. Actually the, the counsellor was very distant, she was, used to sit in a corner far away. And I remember telling her after the sessions, the six sessions, she said, 'I don't see you any more,' and I said this is like I want to say goodbye properly. And because the Latin American way is to give a hug, and to closeness but she just stretched her hands like that and just so I just felt it was a waste of time and then I became suicidal. In my head there was a picture of a baby, a baby, an unborn baby and I could see the umbilical cord and everything and I remember because she, she probably gave me another few session afterwards and she asked me what was the feeling and where does the cord link to, goes to? And I said, 'It ends in this room.' And since then, I became suicidal really. And I couldn't get rid of the thoughts and gradually working with my anger they went and I cut my medication off and so.

So you mentioned I think going to hospital'?

Yeah

When did that happen?

[Laughs] Yes that was, I suppose I was already feeling suicidal.

Was this around the same time then?

After the sessions with the counsellor, because, I took my daughter one day to school and I, and these thoughts of killing myself terrified me, I knew that my husband was not at home, he had gone to post office, somewhere nearby and I didn't want to go back to the house on my own. I went to the doctors which is just around the corner and I told one of the staff how I was feeling and they spoke with the doctor and the doctor said for me to stay, that they would keep phoning home until my husband was there so I could go. But I suppose they also saw the danger of me being on my own anywhere and they suggested for me to go to the hospital.

ECT (electroconvulsive therapy)ECT can be used to treat severe cases of mental illness and involves passing an electrical current across the person's brain under anaesthetic. Only one person had experience of ECT, and he found it helped him (see our section devoted to experiences of ECT for more information).

And from then on in after I'd, after I was an in-patient for three months and I had electro convulsive therapy, or shock treatment, whatever you want to call it. That seemed to help me greatly, I had three, three treatments a week for three weeks, I had nine treatments altogether and that was a, that was a great gift because all that did was it , it calmed down whatever was bothering me and sort of put it to one side. And at the same time all I, all I forgot, because it does affect your memory, it does affect some parts of your memory, all I forgot was my life in England for the final year before I left back to Australia. So I forgot about all the movies I'd seen and I knew I'd seen them but I couldn't remember the plot and I couldn't remember my farewell party or anything like that. So now I'm back in England, it's wonderful, how everything is sort of vaguely familiar, it's, you know, it's new, at the same time it's new, it's a delight, you know. But anyway so the shock treatment or the ECT was very helpful to me and so I spent three months as an in-patient and then about six months as an out-patient where I used to go back and see the psychiatrist every fortnight and he'd have a look at my medication and there'd be a bit of a chat and there might be some group therapy with some of the other patients, other out-patients. And that seemed to work really well.

Other people had not tried ECT. Some definitely didn't want to try it because they had heard it could cause memory loss, including one man who was afraid after seeing people who had tried it and said: “It's basically turned them into the walking dead”. Others had mixed feelings about ECT and had considered it because their medication was not working, although one man said, “I first want to know what it does, what's it for?” Another man asked for ECT, even though he was worried about the damage it might do. As he said, “I've only got one brain, unlike two eyes and two ears.” However, his psychiatrist refused.

At [psychiatric hospital] I met a Professor of Psychiatry and another doctor. And then I was telling my life story like this. Then they told me electric shock treatment. Previously I asked all the psychiatrists and no one wanted to give it to me. They said you're not as bad as you think and we don't agree with you. So when I went to [psychiatric hospital] they said, 'Well if you are really suffering like that this, you can try it.'

Then I belong to a research group in Institute of Psychiatry called CRAG, Consumer Research something, a group, and then I met some members and some said to me, 'Oh yes, I have taken it. It was a quick cure. Or quick relief. I recommend it.' Then another lady sort of said, 'No, no, no, it caused me memory loss. I went through hell and I wouldn't touch it with a barge pole.' So that's the sort of difference of opinion.

So when I asked this Professor, they said to me, 'Look on the net and make your mind up.' I wish somebody would tell me, 'Look go and do it.' So then I thought to myself. Inside I'm still suicidal, I am going through hell. We have tried everything, come what may, even if my brain fries I'll go and do it. So then, when was it, about three months ago, when the depression came in, I told my GP, and she contacted [psychiatric hospital], and [psychiatric hospital] backed down, and [psychiatric hospital] said, 'No, no, no, unless the person is really bad,' but I should have taken the offer then. But then when they first told me I was scared as well.